'Shouting from the sidelines will secure more newspaper column inches than engagement, but it will achieve less'

Next week the British Medical Association council elects its new chairman. Besides getting a new leader, doctors attending the BMA annual conference will be setting the tone for their relations with government as the new ministerial team takes over.

If last week's annual conference of BMA local medical committees is anything to go by, constructive engagement with Gordon Brown's administration will be thin on the ground. In a gesture so pointless it would have been better suited to a sixth form debating society than a meeting of medics, they passed a vote of no confidence in the health secretary and the government's handling of the NHS.

In case anyone had not had their fill of empty rhetoric, BMA chairman hopeful Hamish Meldrum accused some primary care trusts of conducting a 'witch hunt' against GP practices.

Shouting from the sidelines will secure more newspaper column inches than engagement, but it will achieve less. And it would be a mistake to assume the public will always take the medics' side. GPs are already beginning to suffer a public relations backlash over the perceived discrepancy between their pay and the service they provide.

The BMA's leadership has a great deal to offer in helping to shape reforms. The health service will be far better served if the association exerts real influence from inside the tent and resists the urge to substitute cheap shots for substance.